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Resident Manual of Trauma to the Face, Head, and Neck
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Preface
The surgical care of trauma to the face, head, and neck that is an
integral part of the modern practice of otolaryngology–head and neck
surgery has its origins in the early formation of the specialty over 100
years ago. Initially a combined specialty of eye, ear, nose, and throat
(EENT), these early practitioners began to understand the inter-rela-
tions between neurological, osseous, and vascular pathology due to
traumatic injuries. It also was very helpful to be able to treat eye as well
as facial and neck trauma at that time.
Over the past century technological advances have revolutionized the
diagnosis and treatment of trauma to the face, head, and neck—angio-
graphy, operating microscope, sophisticated bone drills, endoscopy,
safer anesthesia, engineered instrumentation, and reconstructive
materials, to name a few. As a resident physician in this specialty, you
are aided in the care of trauma patients by these advances, for which we
owe a great deal to our colleagues who have preceded us. Additionally,
it has only been in the last 30–40 years that the separation of ophthal-
mology and otolaryngology has become complete, although there
remains a strong tradition of clinical collegiality.
As with other surgical disciplines, significant advances in facial, head,
and neck trauma care have occurred as a result of military conflict,
where large numbers of combat-wounded patients require ingenuity,
inspiration, and clinical experimentation to devise better ways to repair
and reconstruct severe wounds. In good part, many of these same
advances can be applied to the treatment of other, more civilian
pathologies, including the conduct of head and neck oncologic surgery,
facial plastic and reconstructive surgery, and otologic surgery. We are
indebted to a great many otolaryngologists, such as Dr. John Conley’s
skills fromWorld War II, who brought such surgical advances from
previous wars back to our discipline to better care for patients in the
civilian population. Many of the authors of this manual have served in
Iraq and/or Afghanistan in a combat surgeon role, and their experiences
are being passed on to you.
So why develop a manual for resident physicians on the urgent and
emergent care of traumatic injuries to the face, head, and neck? Usually
the first responders to an academic medical center emergency depart-
ment for evaluation of trauma patients with face, head, and neck injuries
will be the otolaryngology–head and neck surgery residents. Because
there is often a need for urgent evaluation and treatment—bleeding and